Dr. Lucienne Marie Ide
Home blood glucose monitoring was first introduced in 1980. While there were initially hurdles to overcome related to accuracy and cost, a consistent hurdle since that time has been efficient data sharing between patients and their healthcare team. The introduction of continuous glucose monitoring (CGM) and rapidly expanding access to and adoption of this technology feels like the beginning of a new era in diabetes management, yet the fundamental problem of data sharing remains a barrier to maximal impact of these advances. By leveraging CGM technology, providers can gain much better insights into the details of their patients’ glycemic control and recommend targeted medication or behavioral adjustments to improve outcomes. Being able to do this in a proactive and timely manner relies on the ability for patients to share their data with their healthcare team outside of clinic visits.
Traditional glucose monitoring methods present challenges
Traditional glucose monitoring methods, such as fingerstick testing, are widely used but present several limitations. These methods require patients to manually prick their fingers to obtain blood samples, which are then analyzed for glucose levels. While it seems simple, this process can be painful and does not yield a complete picture of an individual’s glycemic control. If an individual tests once or up to four times daily, that is still a small sampling of their glucose patterns throughout the day. So the process may be uncomfortable, may not allow for discretion when traveling or dining out, and may not yield the most actionable data and therefore many people are not compliant with their glucose testing.
However, excessive monitoring can be detrimental too, as unnecessary fingersticks result in needless work, worries and expenses. In fact, research shows that 1 in 7 individuals with type 2 diabetes undergo unnecessary daily fingersticks, highlighting the need for a more balanced approach to glucose monitoring.
Continuous monitoring data is valuable to patients and providers
CGM devices use a small filament inserted under the skin, usually on the back of the upper arm or abdomen, to continuously measure glucose levels in interstitial fluid. The CGM wirelessly transmits data to a receiver or smartphone app, providing individuals with insight into their glucose readings in real time.
Additionally, CGM systems can identify trends and patterns in glucose levels. When the data and accompanying reports are shared with the healthcare team, clinicians are able to understand how different factors affect a patient’s glucose levels. With personalized insights and alerts for high and low glucose trends, these tools enable timely interventions and care plan adjustments.
We are now in an era in which digital health is part of everyday healthcare delivery. Most patients and providers have now experienced various forms of telehealth from telemedicine video visits to remote patient monitoring. CGM data is a great example of patient-generated health data that can be shared with the clinical team remotely and used to enable more accurate and informed decisions for managing diabetes. By facilitating seamless communication between patients and providers, these tools promote a collaborative approach to diabetes management. Moreover, efficient monitoring enabled by CGM reduces the necessity for frequent in-person visits, resulting in optimized resource allocation and cost savings for both patients and healthcare systems.
CGM enhances patient knowledge and improves outcomes
Countless studies have showcased the effectiveness of CGM in improving glycemic control. Research shows that CGM usage leads to reductions in HbA1c levels and a decrease in hypoglycemic events.
In addition, patients using CGM tools often report feeling more in control of their diabetes, which is logical since they’re receiving real-time insights into their bodies’ responses to various foods, activities and stressors. When patients track their glucose levels immediately after trying a new food, they can determine whether it should be combined with exercise to mitigate a potential blood sugar spike. CGM empowers patients to identify patterns in the interactions between their lifestyle choices and glucose levels.
Setting the stage for fewer complications and a better quality of life can lead to significant cost savings, as fewer complications translate to lower healthcare expenditures. Notably, one of the largest studies of Medicare claims data demonstrated that avoidable complications of diabetes cost the US healthcare system $37B in 2017. One example is kidney disease which can progress to kidney failure that can cost an individual patient approximately $5k per year to treat kidney disease then $54k per year if it progresses to kidney failure then $80k if that individual needs a kidney transplant. This entire sequence could possibly be avoided with better glycemic control.
Practical implementation of CGM requires preparation
Many healthcare providers are considering the adoption of CGM in their practice because patients often ask about this technology at a visit. An engaged patient is a great place to start this journey! As they consider prescribing CGM, providers will then want to understand insurance coverage for CGM in their patient population given their most common payers in their patient panel. Once they have clarity on which patients have access to this technology, they will want to become familiar with how to access their patients’ CGM data and how to best interpret the data and standard reports, such as the Ambulatory Glucose Profile, that accompany the data. Finally, it is crucial to consider the clinical workflow around CGM data and how to seamlessly integrate with existing electronic health record (EHR) systems, streamlining workflows and maximizing efficiency.
Providers may encounter common patient-related barriers and concerns when recommending CGM to their patients. Potential users often express apprehensions about the cost of CGM technologies as well as concerns about wearing a device, including self-consciousness, discomfort and pain. Additionally, data privacy and security worries may also arise. Providers can acknowledge and address these concerns through open dialogue, education, and support, helping people with diabetes to understand that the benefits of CGM often outweigh the drawbacks. By doing so, providers can facilitate increased usage and effective utilization of CGM systems to improve patient outcomes.
Continuous Glucose Monitoring tools are revolutionizing the way diabetes is managed, offering unparalleled benefits for both healthcare providers and patients. By providing continuous, accurate data, CGM is especially useful for remote monitoring, enabling timely interventions and leading to better user health. Medical providers and health system leaders who advocate for the widespread adoption of CGM technology will help their organizations stay at the forefront of diabetes care, ultimately enhancing the lives of their patients.
Photo: gustavofrazao, Getty Images
Lucienne Marie Ide, M.D., PH.D., is the founder and CEO of Rimidi, a cloud-based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.
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